Emocha Mobile Health lands three new contracts for its app to beat latent tuberculosis.

A Baltimore startup with a mobile application to keep tuberculosis patients on track with their medication regimen is expanding with new contracts in California and big ideas for how the technology can improve oversight of medications for other illnesses.

Emocha Mobile Health, founded in 2013 on technology licensed from the Johns Hopkins University, has recently landed contracts with Fresno, Merced and Contra Costa counties in California. Those communities have some of the country's highest concentrations of latent tuberculosis, a form of the lung bacteria that does not have symptoms and puts patients with weakened immune systems at greater risk for developing the potentially deadly disease.

The new contracts represent a vote of confidence for emocha's mobile app as a tool to both improve medication adherence among patients and efficiency within the public health departments responsible for overseeing their care. The app is already in use in Baltimore and several other counties in Maryland, as well as in Texas and Australia.

"Maryland, Texas and California have strong advocates who are customers, and they're the type of customers who are going to improve the product," said Sebastian Seiguer, emocha's co-founder and CEO.

Emocha designed its mobile app, miDOT, for use among tuberculosis patients because treating the illness, a bacterial disease that primarily affects the lungs, requires taking medication at least once a week for between three and nine months, under the watch of a nurse or health worker.

The app lets patients film video of themselves taking their medication, which is sent to a doctor or nurse to review. Medical providers also can keep tabs on symptoms and how patients are feeling on a daily basis.

The stakes are high because patients who fail to take the medication properly or don't finish the round can develop a resistance to the drugs, making it harder to beat the disease. What's more, the process is a big investment for public health departments because they typically send a nurse or health worker to observe patients taking their weekly doses.

Watching patients take medication by video saves time for nurses who can instead focus on other duties and patients, said Baltimore City Health Commissioner Dr. Leana Wen.

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"Our health care system is, unfortunately, not designed with the patient at the center. It's not an effective system to have a person come to the clinic every day, wait in line, sign in, get their paperwork done — just to watch them take medications," Wen said. "That's why technology can be helpful in increasing tracking and increasing flexibility and availability of treatment for patients."

Baltimore hasn't been using the program long, only since 2014, but Wen said early results are promising.

In California, about 2.4 million people, or 6 percent of the population, have latent tuberculosis, according to the state health department. The counties want to work to identify and treat latent tuberculosis because patients who have it are more likely to develop the disease, which can be fatal.

One of emocha's new partners, the Contra Costa Health Services, also might test the app's effectiveness in monitoring symptoms among people who were exposed to measles, a disease that can take days to manifest itself after exposure.

While monitoring returning travelers during the Ebola outbreak a couple of years ago, Contra Costa health officials realized how valuable it would be to have a program that allowed them to remotely track symptoms of communicable diseases.

"We had to monitor returning travelers taking their temperature daily. Similarly with measles you have to contact them daily and ask if they have symptoms," said Dr. Louise McNitt, the county health department's communicable disease controller.

She thinks the program could be helpful for monitoring other outbreaks.

"You never know what's around the corner," McNitt said.

Emocha hopes its work in California will open the door to applying the app to other infectious illnesses that require close monitoring and can be difficult to track.

The mobile technology miDOT was built on was developed at Hopkins in 2008 as a tool for global clinical health research. Seiguer, a lawyer who returned to school for a business degree from Hopkins, learned about the technology while working at Hopkins' technology commercialization office. He and co-founder Morad Elmi licensed it in 2013.

Emocha is based at Hopkins' business accelerator FastForward East, located near Hopkins Hospital, and employs nine people.

Since founding the company, Seiguer has considered tuberculosis just the start for emocha. The company has done some testing for a version of the app for hepatitis C, and in September will launch a larger pilot with eight academic medical centers.

A full round of hepatitis C medication costs about $84,000, so completing the regimen is important.

"Financially, TB is kind of this really unique disease," Seiguer said. "If we prove [the technology] in this very tough population, you can take it on to other disease states."